World Sepsis Day

September 13, 2012 marks the first World Sepsis Day, an international event aimed at increasing awareness and decreasing the incidence of a preventable and treatable disease that kills 10,000 people every day. 

Ramona, Whitney, Heidi and Alana were the lucky ones.  When they developed sepsis after delivering their babies, they received medical treatment that saved their lives.  Orfa was lucky too.  Featured in our documentary, No Woman No Cry, Orfa made it to a hospital in Guatemala after her miscarriage resulted in multiple uterine abscesses.  An astute doctor recognized her “miscarriage” may have resulted from an unsafe abortion and started her on antibiotics in time to reverse septic shock. 

For every mother who survives, approximately 73,000 to 100,000 do not.  Sepsis is the third leading cause of maternal death in the US and other developed countries.  It’s number two in the developing world.  According to global medical experts, including Jim O’Brien, MD, MSc, an intensive care unit doctor on the board of directors for Sepsis Alliance (a charitable organization working to raise awareness about sepsis), half of the 258,000 people who die annually from sepsis could be saved with simple, rapid, antibiotic treatment. 

What is sepsis?  The Global Sepsis Alliance explains:

Sepsis arises when the body’s response to an infection damages its own tissues and organs. It can lead to shock, multiple organ failure, and death, especially if it is not recognized early and treated promptly. Between one-third and one-half of all sepsis patients die. In developing countries, sepsis accounts for 60-80% of all deaths. It kills more than 6 million infants and young children, and 100,000 new mothers every year.

How about maternal sepsis? The World Health Organization says: 

Maternal sepsis, also called “puerperal sepsis”, is defined as infection of the genital tract occurring at any time between the onset of rupture of membranes or labor and the 42nd day postpartum, in which fever and one or more of the following are present: pelvic pain, abnormal vaginal discharge, abnormal smell/foul odor of discharge and delay in the rate of reduction of the size of the uterus.  In the absence of treatment, maternal sepsis may lead to death and serious long-term morbidity [illness and complications] such as chronic pelvic pain, pelvic inflammatory disease and secondary infertility. 

How does maternal sepsis happen?  Childbirth isn’t a squeaky clean event.  Bacteria from the skin, feces, vagina, abdomen and birthing environment can nestle into a wound (like a vaginal tear, C-section incision or the irritated lining of the uterus) and grow. That bacteria multiplies rapidly, invades other tissues, gets into the bloodstream and in no time at all, infects and damages major body organs, which start shutting down.  If treated quickly with antibiotics, chances for survival are high.  If not, death can occur within hours. There are multiple risk factors associated with maternal sepsis including unhygienic home birth, unsafe abortions, living in poverty, poor nutrition, and C-sections.

Dr. O’Brien says, “Sepsis should be considered a medical emergency just like heart attack and stroke.  For every five minutes treatment is delayed, chances for death increase by one percent.  In countries like the US, only 50 percent of patients with septic shock get antibiotics within six hours.  That means 50 percent don’t.  When they present to the hospital, they all eventually get antibiotics, but it might be too late. After 24 hours passes, it doesn’t matter if they get antibiotics or not.  There’s a very narrow window for effective treatment and we have to do a better job of recognizing the signs and starting treatment. 

Why aren’t more patients getting treatment? Part of the problem is that clinical symptoms and laboratory tests used to diagnose it aren’t specific enough. O’Brien says, “There’s no single test to adequately diagnose sepsis. Plus, it takes time to get lab values back and we can’t delay treatment by waiting.” Doctors are taught to look for abnormal body temperature, increased pulse or breathing rate, and an abnormal white blood cell count, but many patients die from sepsis without demonstrating those symptoms.  O’Brien says, “With pregnant women, many of those symptoms are also normal variations of pregnancy.  All term pregnant women have rapid heart and respiratory rates and their white blood cells are often high or low. Lots of women run temperatures during labor and all that could be normal. But, doctors aren’t recognizing other factors that indicate sepsis or aren’t starting treatment quickly enough.”

Doctors have been drilled to avoid overusing antibiotics and O’Brien says that’s among of the most widely heard reasons why doctors delay treatment. “Sepsis is on the rise and requires rapid treatment with antibiotics, but it’s also vital we use antibiotics thoughtfully. That means not prescribing them for things like colds when we know they’re unnecessary.  We also need more thoughtful approaches in our use of antibiotics on livestock because 60 to 80 percent of the antibiotics used in this country are used preventatively on animals that aren’t sick.  We don’t know how that’s affecting our own bacteria.”

How about in the developing world? In Africa, Southeast Asia and other parts of the developing world, it’s all about access.  There are few hospitals, not enough medicines, doctors or ways to get patients to medical treatment. That’s why so many mothers die from sepsis.  Without access to clean, safe, birth facilities and antibiotics and doctors and nurses to administer them, women who develop sepsis don’t stand a chance. 

What can you do?

O’Brien says, “We need to raise public awareness about sepsis.  We need the public to get the medical community focused just like they did with HIV and breast cancer.”

• Check out the World Sepsis Day website to find events in your area and help get the word out.
• Attend the Sepsis Alliance’ Sepsis Heroes Event in New York City and celebrate individuals and healthcare organizations making a difference in sepsis outcomes. 
• Log on to Sepsis Alliance and Global Sepsis Alliance to learn more and donate funding for research.